AB0419 RHEUMATOID ARTHRITIS SWITCHING PATTERNS AND THE GROWTH OF SMALL MOLECULE TREATMENT IN THE EU5
Authors: M. Yarnall, P. C. Taylor, P. Pouliot, E. Hettel, K. Murray
Journal: Annals of the Rheumatic Diseases (2022)

Background TNF-α inhibitor therapy has long been the standard of care for adult patients diagnosed with moderate to severe rheumatoid arthritis (RA) across the EU5, though several new biologics, biosimilars, and small molecules have become available for the treatment of RA. Objectives This research sought to understand the factors influencing treatment changes when patients are switched from one biologic or small molecule to another, including the reason(s) for their treatment selection. Methods An independent market analytics firm collaborated with EU5 rheumatologists (n=250 across France, Germany, Italy, Spain, and the UK) to conduct a retrospective chart review of patients diagnosed with RA (n=1,268) who had switched from one biologic therapy or small molecule agent to another in the prior twelve weeks. Data were collected in August and September 2021 and included clinical and non-clinical patient demographics as well as physician demographics and attitudinal survey responses. This study was a non-longitudinal trending analysis to 2020 (n=1,288), 2019 (n=1,294), 2018 (n=1,312) and 2017 (n=1,235) audits following the same methodology. Results 70% of surveyed rheumatologists reported recent changes to the management of their RA patients, with the most recalled treatment shift being an increased use of small molecule agents (JAK inhibitors, 30%), attributable to the introduction of upadacitinib and filgotinib in December 2019 and September 2020, respectively. Despite a plethora of RA treatment options in the EU5, annual physician-reported rates of RA patient switching have remained stable since 2017, with 25% of biologic/small molecule-treated patients switching brands within a given year. There has been a steady increase in switches from TNF inhibitors to JAK inhibitors over the last few years (2% in 2017 to 19% in 2021). At the same time, the rates of TNF cycling have been on a downward trend (43% in 2017, 40% in 2018, 39% in 2019, 34% in 2020, and 32% in 2021). Rheumatologists indicate 44% of their RA switch patients were switched from a TNF to a JAK inhibitor due to secondary efficacy failure, and their primary reason for selecting a JAK was due to the specific MOA (40%) and dosing delivery (19%). TNF cycling (both branded and biosimilar) represent one-third of all switches in the EU, making it the most common switch pattern. TNF cycling remains most common in Germany and Spain, while France observes the lowest switch rates between TNFs. The incidence of switches from TNFs to JAK inhibitors is more consistent across countries but remains highest in Germany. Figure 1. Conclusion The introduction of small molecule agents in the EU over recent years (upadacitinib and filgotinib) has provided new options for the treatment of RA, creating a shift in the switching arena from TNF cycling to more utilization of alternate mechanisms of action post first line therapy in favor of JAK inhibitors. References None Disclosure of Interests Maxine Yarnall: None declared, Peter C. Taylor Consultant of: Received consulting fees from AbbVie, Biogen, Eli Lilly, Fresenius, Galapagos, Gilead Sciences, GlaxoSmithKline, Janssen, Nordic Pharma, Pfizer Inc, Roche, and Sanofi., Grant/research support from: Received research grants from Celgene and Galapagos., Phil Pouliot: None declared, Emily Hettel: None declared, Kara Murray: None declared